by Antonella Sparvoli
Microtraumas and support defects favor heel pain. In the acute phase, ice packs and anti-inflammatories are recommended. The use of surgery is rare
Heel pain is a symptom that is as common as it is annoying, also because it often tends to become chronic. Precisely for this reason, it is better not to underestimate it.
What are the most frequent causes of heel pain?
«Inflammatory pathologies that concern the insertion of the plantar fascia (a fibrous tissue that extends from the heel to the toes) or the Achilles tendon to the heel, are the most common causes of heel pain – stated Silvia De Martinis, orthopedist at the First Orthopedic Clinic Asst Gaetano Pini-CTO in Milan —. In the first case the pain is felt mainly in the most plantar part of the heel, while in Achilles tendinopathy the pain is localized in the back part of the heel, where the Achilles tendon inserts onto the heel. In both cases, inflammation can be favored by a series of factors, starting from mechanical overload and repeated microtraumas, accomplices to possible defects in the support of the foot, such as a flat, hollow or overpronated foot, i.e. which falls inwards” .
How is it characterized?
«In the case of plantar fasciitis the pain tends to appear especially when starting the engine after a period of rest, for example in the morning as soon as you wake up, while in tendinopathy of the Achilles tendon it is typically felt with physical activity. These pathologies can present themselves with occasional episodes, but not infrequently, especially in the case of plantar fasciitis, there is a chronicity, generally because the pain is underestimated. Furthermore, the development of calcifications at the point of insertion of the plantar fascia or the Achilles tendon into the heel and sometimes of bursitis in the posterior part of the heel is frequent.”
How can it be counteracted?
«In the acute phase, ice packs, anti-inflammatories and rest are helpful, however if the pain persists it is a good idea to have an orthopedic visit to trace the cause of the heelitis. The specialist can then suggest further investigations such as x-rays, to exclude other pathologies, for example stress fractures (common in runners), and ultrasound to evaluate the plantar fascia and the state of the Achilles tendon.”
When is surgery needed?
«The treatment of plantar fasciitis is almost always conservative and involves the correction of any biomechanical defect with specific insoles, stretching exercises and massage with a roller or tennis ball to relax the fascia. Additionally, weight loss is recommended if you are overweight. «In both conditions, focal shock waves and possible infiltrative therapy with PRP (Platelet Rich Plasma), a concentrate of the patient’s own platelets, are useful. In the case of Achilles tendinopathy, other physical therapies such as tecartherapy can also offer benefits. The use of surgery in plantar fasciitis is very rare, also because in most cases, in a more or less long time, it resolves with conservative treatment. The Achilles tendon, on the other hand, is more at risk of rupture, which is why scarification surgery to stimulate its repair is more common”
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December 10, 2023 (changed December 10, 2023 | 07:27)
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